SPECIFIC SPEECH ARTICULATION DISORDER

A specific developmental disorder in which the child's
use of speech sounds is below the appropriate level for his or her mental age, but in which there is a normal level of language skills.

Diagnostic guidelines:
The age of acquisition of speech sounds, and the order in which these sounds develop, show considerable individual variation.

Normal development. At the age of 4 years, errors in speech sound production are common, but the child is able to be understood easily by strangers. By the age 6-7, most speech sounds will be acquired. Although difficulties may remain with certain sound combinations, these should not result in any problems of communication. By the age 11-12 years, mastery of almost all speech sounds should be acquired.

Abnormal development occurs when the child's acquisition of speech sounds is delayed and/or deviant, leading to: misarticulations in the child's speech with consequent difficulties for others in understanding him or her; omissions, distortions, or substitutions of speech sounds; and inconsistencies in the co-occurrence of sounds (i.e. the child may produce phonemes correctly in some word positions but not in others).

The diagnosis should be made only when the severity of the articulation disorder is outside the limits of normal variation for the child's mental age; nonverbal intelligence is within the normal range; expressive and receptive language skills are within the normal range; the articulation abnormalities are not directly attributable to a sensory, structural or neurological abnormality; and the mispronuciations are clearly abnormal in the context of colloquial usage in the child's subculture.

Include: - developmental articulation disorder
              - developmental phonological disorder
              - dyslalia
              - functional articulation disorder
              - lalling 

Excludes: articulation disorder due to:
              - aphasia NOS (R47.0)
              - apraxia (R48.2)
              - articulation impairments associated with a developmental disorder of expressive or receptive language (F80.1, F80.2)
             - cleft palate or other structural abnormalities of the oral structures involved in speech (Q35-Q38)
             - hearing loss (H90-H91)
             - mental retardation (F70-F79)

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